Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes

Review

Intervention

Authors

Joanna Tieu,

Corresponding author

The University of Adelaide, ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Institute, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia

Joanna Tieu, ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 1st floor, Queen Victoria Building, 72 King William Road, Adelaide, South Australia, 5006, Australia. joanna.tieu@gmail.com. joanna.tieu@mh.org.au.

Abstract

Background

Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for both mother and infant both perinatally and long-term. Women with a history of GDM are at risk of recurrence in subsequent pregnancies and may benefit from intervention in the interconception period to improve maternal and infant health outcomes.

Objectives

To investigate the effects of interconception care for women with a history of GDM on maternal and infant health outcomes.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013).

Selection criteria

Randomised controlled trials, including quasi-randomised controlled trials and cluster-randomised trials evaluating any protocol of interconception care with standard care or other forms of interconception care for women with a history of GDM in a previous pregnancy on maternal and infant health outcomes.

Data collection and analysis

Two review authors independently assessed study eligibility. In future updates of this review, at least two review authors will extract data and assess the risk of bias of included studies.

Main results

One ongoing trial was identified. No eligible completed trials were identified.

Authors' conclusions

The role of interconception care for women with a history of gestational diabetes remains unclear. Randomised controlled trials are required evaluating different forms and protocols of interconception care for these women on perinatal and long-term maternal and infant health outcomes, acceptability of such interventions and cost-effectiveness.

Plain language summary

Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes

Gestational diabetes mellitus (GDM) is a condition in which high blood sugar (hyperglycaemia) occurs, or is first recognised, during pregnancy. GDM is associated with complications for the mother and her baby both during and after pregnancy. Women with GDM are at an increased risk of developing pre-eclampsia (high blood pressure and protein in the urine during pregnancy), having a caesarean birth, and developing type 2 diabetes in the future. Babies of women with GDM are at an increased risk of macrosomia (birthweight greater than 4000 g), birth trauma because of their size, respiratory distress syndrome, and other health complications. They are also at risk of future obesity and type 2 diabetes. GDM typically resolves after birth, but women with GDM are at risk of developing GDM again in future pregnancies. It is possible that women may benefit from interventions such as education, dietary and lifestyle advice, or drug treatment in the interconception period (the time between the end of one pregnancy and the beginning of the next one), to improve their health outcomes in future pregnancies.

This review found that there is not yet enough evidence to determine whether interconception (between pregnancy) care for women with a history of GDM can help to improve the health of mothers and their babies. We identified only one trial that is currently ongoing. More high-quality studies are needed, and these studies should evaluate different forms of care for these women, and should assess both short-term and long-term health outcomes for women and their babies.